This proposal is a revision of R01 AA020063-01 that was reviewed in June 2010 by BGES. The revisions address methodological shortcomings. The project remains significant because suicide is a major national public health problem with about 30,000 deaths each year, representing the 11th leading overall cause of death and the 5th leading cause of years of potential life lost (YPLL) before age 65. Alcohol plays a key role in suicide and, indeed, according to the Centers for Disease Control and Prevention, 6,969 deaths and 235,865 YPLL resulted from alcohol-attributable suicides in 2001. Although alcohol use disorders and suicide have been intensively studied, there is comparatively little research on acute alcohol use and suicide (i.e., drinking prior to the event). Yet, data on acute alcohol use is essential for developing a comprehensive suicide prevention strategy. Research on toxicological characteristics of suicide decedents in the United States has been constrained by small samples and limited geographic coverage. This project will address these limitations using newly available data from the National Violent Death Reporting System (NVDRS), a large (47,398 suicide decedents in 2003-08) and demographically well-characterized database with toxicology information (blood alcohol concentration, BAC) as well as coroner and medical examiner reports pertaining to suicides. The project aims are as follows: (1) describe the epidemiology of blood-alcohol content among suicide decedents in the United States and among major subgroups defined by age, gender, and ethnicity; (2) compare BAC presence and levels at time of suicide to estimated BAC presence and levels in a matched general population control group; (3) examine blood-alcohol content presence and levels in relation to suicide involving different methods (e.g., firearm, hanging, or drug ingestion); and (4) test the effects of alcohol control policies on alcohol-related suicides compared to non-alcohol-related suicides. The project will also examine geographic and temporal variation among those who were and those who were not using alcohol at the time of suicide. The research is built on a multi-level framework in which counties are nested within states. Key environmental predictors will include data on population drinking patterns from the National Epidemiologic Survey on Alcohol and Related Conditions, alcohol availability indicators from the US Census Bureau Business and Industry Data, alcohol tax rates from the Tax Foundation, and firearm access indicators from the Behavioral Risk Factor Surveillance System. Documenting the alcohol-associated suicide mortality levels and trends over time, estimating the risk for the most commonly used method of suicide with alcohol involvement, and evaluating the effects of alcohol control policies on alcohol-positive suicides address fundamental gaps in the understanding of alcohol use in suicide with implications for the harmonization of alcohol policy and suicide prevention strategies.